Tuesday, January 18, 2011

During the Phil Spector retrial, I did several Q & A entries for those who followed my trial coverage. I thought it might be helpful to some if we had a similar entry for the Dr. Murray prelim. I've closed the comments on all the Dr. Conrad Murray Prelim entries so that new questions regarding the prelim can be left here. Our guest commentator, KZ, a practicing nurse anesthetist, has graciously agreed to help answer the medical questions.

How this will work. You can submit a question by leaving a comment on this entry or emailing me, Sprocket, directly. There is a link to my email on my profile page. This entry will be periodically updated as questions come in. Questions we can answer (and some of those we can't; if we don't know, we'll tell you) will be posted as part of the entry and answered in the entry. A reminder about T&T's comment policy. T&T is not obligated to publish all comments.

I will start this off by addressing the specific charge of involuntary manslaughter against Dr. Murray.

INVOLUNTARY MANSLAUGHTER CHARGE

COMMENT KZ posted on January 4th, 2011:I am so glad that you are covering this trial. As an anesthetist, I can say that our entire profession is disgusted and horrified at what Conrad Murray was doing under the guise of providing medical care. He should permanently lose his license in every state, as well as go to prison. I know they're charging him with manslaughter because that is what the prosecutors think they can make "stick", but in my opinion it was criminally negligent homicide or second degree murder. There is no home use of propofol that is justifiable, and that a cardiologist was administering it is patently absurd. Cardiologists ARE NOT trained to administer anesthesia drugs, and are completely unqualified to do so. He would not have been given privileges in ANY hospital to administer propofol, as a cardiologist. And 25mg is not any kind of "usual" dose, lol. That is ridiculous! Conrad Murray didn't know what the hell he was doing, and he killed his "patient". Period, the end. I will watch and read with great interest.

At this link, you can read the California Penal Codes covering homicide (187, 188) and manslaughter (192). There is no charge labeled "criminally negligent homicide."187. (a) Murder is the unlawful killing of a human being, or fetus, with malice aforethought.

188. Such malice may be express or implied. It is express when there is manifested a deliberate intention unlawfully to take away the life of a fellow creature. It is implied, when no considerable provocation appears, or when the circumstances attending the killing show an abandoned and malignant heart.

When it is shown that the killing resulted from the intentional doing of an act with express or implied malice as defined above, no other mental state need be shown to establish the mental state of malice aforethought. Neither an awareness of the obligation to act within the general body of laws regulating society nor acting despite such awareness is included within the definition of malice.

192. Manslaughter is the unlawful killing of a human being without malice. It is of three kinds:(a) Voluntary--upon a sudden quarrel or heat of passion.(b) Involuntary--in the commission of an unlawful act, not amounting to felony; or in the commission of a lawful act which might produce death, in an unlawful manner, or without due caution and circumspection. This subdivision shall not apply to acts committed in the driving of a vehicle.(c) Vehicular--

So, 187 is first degree murder, 188 is second degree murder and 192b is involuntary manslaughter.

I've read around the web a bit and some people seem to think that if they sign a petition and get enough signatures, the LA County DA's office will increase the charges against Dr. Murray. I don't believe this will be happening. Here's why. It's my opinion that the DA's office performed a thorough investigation and charged Dr. Murray with the most serious charge they could under California law.

But let's consider a hypothetical, a "what if" if you will. Let's suppose that during the trial, some evidence came to light where Dr. Murray's actions or conduct could be considered second degree murder. Could the DA ask for a second degree murder charge be given in jury instructions? In a nutshell, no, they can't. The DA's office cannot change the charging document if it will substantially prejudice the defendant's rights. They cannot "up the charges" midway through the trial no matter what evidence came to light.

But let's say hypothetically, some evidence did come to light during the trial. What would the DA's office most likely do? It's my understanding (from sources inside the DA's office) that the DA's office would drop the manslaughter charges (the trial would end) and refile new charges for (hypothetically) second degree murder. That would mean a new arraignment and a new preliminary hearing.

While I commend everyone for signing a petition, it won't accomplish a thing. At this point in time, the most Dr. Murray will receive if convicted is four years. It's quite sad when you think about it.

COMMENT by KZ on January 5th, 2011KZ said... Very interesting chain of events described. I'm an anesthetist, so I'd like to comment on the medical chain of events as you have reported them. It's clear to me that MJ was "quite" dead for several HOURS before Murray even noticed he wasn't breathing. If MJ's periphery was "cool" to the touch at 12:25 when paramedics arrived, assuming an ambient temperature of at least 72 degrees in the room, and the body on an insulated bed, clothed, possibly with bed covers over him, it would have taken several hours of cooling for the periphery of the body to feel "cool" to another human's touch. If the body periphery skin temp was even 90+ degrees, it's likely he could have been dead since at least 9 a.m. or earlier. No mention yet of rigor, which usually begins around 4 hours PM. Frankly, I don't doubt that Murray claims to have given him more meds at 10 am-- he simply failed to recognize that his patient was DEAD. A fairly critical error for any health care professional. MJ kept getting propofol infused into his dead body, which was not metabolized or circulated by his non-beating heart. Hence the sky-high blood levels at post. Depends on what rate the infusion was at when he died how much more accumulated. Murray may well have bumped his IV with another 25mg at 10 am-- and I agree that THAT 25mg wasn't what killed his patient! Murray didn't have the skills of any ICU nurse or any first- week- in- the- OR anesthesia student. THAT is what killed his patient. Murray was "nursing" the meds and IV's-- not monitoring and assessing his patient, which can lead to dead patients in hospitals, as well as outside of hospitals. And without a cardiac monitor displaying rhythm and respiratory impedence (hello, you're a CARDIOLOGIST, Murray!), end tidal CO2, or a pulse oximeter, or a stethoscope, he was relying on his completely untrained, and nonexistent assessment skills to detect apnea and lack of a pulse in his patient. And no advanced airway management was ever attempted. I doubt very much that Murray even knows how to position someone's head or jaw to open an airway or assist inadequate respirations, let alone competently use an ambu bag or intubate.That MJ's corpse received 30 minutes of ACLS at the scene with documented asystole (after badly attempted bystander basic CPR), and another 73 min of ACLS at the hospital ER with documented asystole, far, far exceeds what any person would receive who was not known to be severely hypothermic. I cannot imagine what the staff was thinking during that code. And while I agree that it was egregious and incompetent that Murray did not mention the propofol to any of the legitimate medical providers, it would not have made one bit of difference if they had known, as there is no "reversal" agent for propofol. All that info would have done is persuade them that MJ was indeed quite dead, and they would have called the code even sooner.Arrogance, incompetence, greed, and narcissism, plus the all important M.D. after Murray's name, killed his patient. No one forced him to give anything to MJ, who was an addict looking for a source. And MJ wanted propofol not only because it's a great anesthetic, but precisely because it is not a narcotic, and doesn't show up in drug tests. Clean drug tests may have been a condition of his insurance contract for his music tour, sometimes required by producers.

COMMENT by Anonymous on January 13th, 2011I realize it's a bit late to comment in this area but in rereading testimony, etc and KZ's professional opinion, how would KZ, in describing MJ as dead for hours, and being infused while dead, how does that account for his facial expression being missed by Dr. Murray? I don't fully understand the sequence of events/ timeline, so I may be totally misunderstanding here...or, as KZ's comment was written early in the testimony, maybe something has changed.

KZ will answer questions directed to her as soon as she can.

Understand, we have not heard the entire interview Dr. Murray had with detectives. We've only heard a summary. We don't know if questions like these were asked by police.

By Dr. Murray's own time line with detectives as to what he did and when, there is a discrepancy of almost an hour. Dr. Murray states he went to the bathroom "for about 2 minutes" around 11 am.

The phone call with girlfriend Sade Anding at 11:51 am, where she testified that after about 5 minutes, she realized that Dr. Murray wasn't there/listening to her. She heard some commotion in the background and a sigh, as if the phone might have been in a pocket. What happened during that hour? Evidence shows Dr. Murray was receiving and sending E-mails and on the phone. We don't know specifically where Murray was in Jackson's mansion during that hour.

COMMENT by KZ on January 6th, 2011One more comment. Even if the defense is floating theories that MJ woke up and somehow opened the IV and bolused himself, or injected another bump of propofol, I'd submit that the very fact that MJ was unattended with access to propofol and a running IV in place while being treated by Murray constitutes grounds for an involuntary manslaughter charge! That Murray left MJ unattended for even a second is grounds for manslaughter conviction. We don't even need to discuss whether or not Murray should have been giving him the propofol in a home setting. It was Murray's job to ensure the safety of his patient at all times while receiving those kinds of medications-- and he left him ALONE and unmonitored by another human, or any machines. IF he had been monitored at all, there is at least a POSSIBILITY that he could have been resuscitated (assuming CM could have done that, which is in doubt.) When Murray left the bedside, he committed a deadly crime.Murray could have, and should have, said NO to the propofol, but he didn't. Murray took his life. Period.

Dr. Mark Ruffalo, the pharmacologist and anesthesiologist said pretty much the same thing on the stand.

Comment by Anonymous on January 7th, 2011Other places are claiming that these questions were also asked, but you haven't included this in your entry. Can you clarify? Thanksjustice_4mj: Defense asked questions if whether a 5"9" man could have reached a the nightstand to the propofol bottle and inject himself.MJJCommunity: The defence even insinuated that Michael reached across grabbed the 100mg bottle of propofol grabbed an needle and injected himself

Yes, I did hear that question. It was asked but objected to and sustained.

I don't recall a question about asking if someone could inject himself, (there may have been; we lost the feed for a few moments) but all the questions were leading in that direction...basically: Was the IV within reach? Were the needles within reach?" Those questions were not answered because they call for speculation by the witness.

COMMENT by Anonymous on January 17th, 2011I have a question that may seem like breathless arrogance and dumbness, from a novice who has never read any type of trial transcript before this one, but here goes:

Based on the preliminary material, it seems - my personal opinion of course - that Dr. Murray is culpable in at least two regards right up front: 1) delivering substandard care in administering propofol in an inappropriate setting, with all that implies about equipment, mixing other medications, etc - in other words. violating the Hippocratic oath, - and 2) being untruthful to the others in his profession who were also called into this drama and were trying to give good care - the EMC and ER staff, - which, again IMO, undermines his credibility in telling his version of this narrative and, in its own way violates the Hippocratic oath.So this thing will now go to trial - months later, gazillions of testimony later - what's going to make a jury let him off the hook? It's a hypothetical question at this point, but could anyone not agree that even if MJ is involved in any way, that the higher standard would belong to the doctor?

I'm just curious as to what type of defense could be mounted here? There must be something - will it turn on the definition of 'manslaughter' - or is it just to get a reduced sentence, not an acquittal? Reading the defense's questioning and comments, I sense they're trying to implicate everyone else - the EMC crew, Kai Chase, the security detail - in a finely grained argument, for not doing things that would have saved MJ's life. They'll throw dirt at anyone, and some of it will stick, but tho' that's what a good defense lawyer does, will any of it be as egregious as Dr. Murray's behavior, no matter how much doubt is raised about timing, drug amounts, resusitation efforts, or lethal drug doses?

I guess I'm looking for the T&T team to set me straight and knock some sense into my head. :)

What type of defense could be mounted? Well, we've seen a snippet of the defense case so far. It wasn't "involuntary manslaughter." From the questions the defense raised in cross, it's my opinion that the defense case will be accidental suicide. That Michael Jackson, desperate for sleep, woke up and drank propofol or injected the IV that was within reach with propofol.

We still don't know how the defense will attack the credibility of some of the witnesses at trial, but I can take a guess.

The three witnesses that now have Carl Douglas as their attorney. The defense will try, in any way that they can to discredit them. That these three were involved in a cover up, or that they did more than what they said they did. Or, that THEY helped give Michael Jackson the propofol. In my opinion, those are just OFF THE WALL, SPITBALLING suppositions and guesses. I do not know exactly what the defense is going to do. But rest assured, it's my opinion they will try to throw other people under the bus.

But you also have to take into consideration the testimony of the coroner who performed the autopsy and Dr. Ruffalo who testified that even if Dr. Murray did not give Michael Jackson the propofol, his standard of care was so negligent, because he left a drug out where an "addict" could get it.

Many are outraged on two fronts.1) Michael Jackson was NOT an addict and that a witness called him one.2) Propofol is NOT an addictive substance.

I don't know if Michael Jackson was an addict or not. I did not see compelling evidence presented at the preliminary hearing. The only testimony in that regard is from Detective Myers, via Dr. Murray's interview.

However, although some are saying that propofol is NOT physically addicting, it's my opinion that Michael Jackson could have been psychologically addicted to it. I don't hear people mentioning that at all.

COMMENT by Anonymous on January 17th, 2011Can a child as young as Michael Jackson's son be called to the stand to testify? Could one get balanced testimony from a family member like this?

From Kai Chase's testimony, It seems that Prince was the first person on the scene after Muray, not Alberto Alvarez.

We don't have any direct testimony yet to verify Prince actually entered his father's bedroom and saw Michael before Alvarez and Mohamed were in the room.

It appears he might have from Kai Chase's testimony but we don't know for certain.

Children much younger than Prince have been sworn in to testify in many states.

There is a case where, a very young child (can't remember the exact age...possibly 4 years old) was sworn in and testified that he saw his mother put her hand over his older sister's face and hold her head under the water in the family swimming pool.

Under cross examination, he gave quite a bit of conflicting testimony.

She was convicted of murder.

COMMENT by Tiya on January 18th, 2011Sprocket, I enjoy reading the comments section as much as the trial reporting, where you give generously of your knowledge and experience.About your answer to defense strategy, Jackson and drug addiction, self-administering, throwing people under the bus. The msm made short news interviews of several of Jackson's staff right after his death - I recall seeing one by Mike LaPerruque and one by Cheryl Lewis. These two are mentioned in your transcripts, I believe.Besides sharing happy memories of Jackson, LaPerruque, a security guy, spoke of taking Jackson out of meetings, so drugged he couldn't keep his head up. LaPerreque would put Jackson to bed and sit in a chair for hours, watching Jackson to make certain he was still breathing. Cheryl Lewis, a nurse-nutritionist, recalled receiving a phone call from one of Jackson's security staff who was relaying information, with Jackson speaking in the background, complaining of one side of his body feeling hot or cold, I don't recall which after doing 'something'. She told them to call 911 and go to the hospital. These two are both probably wishing they had never spoken! I think the defense will bring out alot of this to bolster their 'self-administering' defense. The security team was probably smart to lawyer up.The individuals you mentioned, Mike LaPerruque and Cheryl Lewis did not testify at the preliminary hearing.

If these individuals gave media interviews, it's understandable (to me) why the prosecution did not call them to testify at the preliminary hearing. Their media interviews, and everything they said in them could be used to impeach them in cross examination.

Any more questions about the Dr. Murray Preliminary Hearing?

COMMENT by June, January 19, 2011I had not heard an interview by LaPerruque, but I did hear many interviewed from Nurse Cherilynn Lee (Cheryl Lewis referred to by another commenter). Rather than go the police right after Michael died, Lee went on Larry King, Nancy Grace, and every other news show that would have her with her story of how MJ sought propofol from her months before his death and how she refused to give it to him. She gave him something called "Myers cocktail" (several times) a natural injection to boost energy. MJ or his staff called her on Father's Day saying MJ was hot on one side cold on the other. Ifi she is credible (which I question), why would MJ be calling her when Murray was supposedly his personal doctor by that time. One would think she SHOULD be called if she had any contact with Michael during Murray's "treatment". She claims her last "contact" with Michael was in April, right before Murray came on board. So in June did Michael not trust Murray enough with his hot/cold complaints, compelling him to turn to Lee for help? Her role needs to be more fully explained and would come out under oath, I think.

My prior comment abaout Nurse Lee: I think she jumped into speaking to the media right after Michael's passing (rather than go the police) to make it appear he was seeking the drug before his death. Why she took this action I will leave to your good judgment. She probably would be impeachable in court as her story varied every time she told it on tv. But due to the timeframe of her having contact with Michael/his staff, at the same time Michael was supposedly under the care of Dr. Murray (in June 2009), causes me to surmise that she should be called at least about the timeframe of events April through June 2009.

It will depend on whether or not any side has anything to gain (promote their theory of what happened that night) by putting these two individuals on the stand. Will these witnesses help or hurt the prosecution or defense case? If Jackson made phone calls to Lee/Lewis, there would be a record. IF a phone call was made, I'm betting he didn't call her from a throw-away-phone or the pay phone at the corner 7-11. You also have to realize that even if Jackson made calls to her, the content of them could have been completely innocent. For example: "Hi, how are you? I haven't seen/spoken to you in a long time! I called because something someone said reminded me of you and I wanted to let you know I was thinking of you and love you." See?

Another thing you have to consider is each and every individual's post-incident actions and if there was an ulterior motive related to those actions.

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comments:

I had not heard an interview by LaPerruque, but I did hear many interviewed from Nurse Cherilynn Lee (Cheryl Lewis referred to by another commenter). Rather than go the police right after Michael died, Lee went on Larry King, Nancy Grace, and every other news show that would have her with her story of how MJ sought propofol from her months before his death and how she refused to give it to him. She gave him something called "Myers cocktail" (several times) a natural injection to boost energy. MJ or his staff called her on Father's Day saying MJ was hot on one side cold on the other. Ifi she is credible (which I question), why would MJ be calling her when Murray was supposedly his personal doctor by that time. One would think she SHOULD be called if she had any contact with Michael during Murray's "treatment". She claims her last "contact" with Michael was in April, right before Murray came on board. So in June did Michael not trust Murray enough with his hot/cold complaints, compelling him to turn to Lee for help? Her role needs to be more fully explained and would come out under oath, I think.

My prior comment abaout Nurse Lee: I think she jumped into speaking to the media right after Michael's passing (rather than go the police) to make it appear he was seeking the drug before his death. Why she took this action I will leave to your good judgment. She probably would be impeachable in court as her story varied every time she told it on tv. But due to the timeframe of her having contact with Michael/his staff, at the same time Michael was supposedly under the care of Dr. Murray (in June 2009), causes me to surmise that she should be called at least about the timeframe of events April through June 2009.

Only a nurse again, but if Mr. Murrey Know that Michael Jackson was hooked on drugs. Then it was his duty not to supply those drugs. Once again we have a lack of standard of care of his doctor to protect his client. IMOP he is responsible for the death of his patient.

QUOTE:Sprocket, there have been some strange recent developments in the Conrad Murray trial - the judge is threatening to levy a $1500/day fine on the defense for not sharing evidence with the prosecution, and the prosecution is requesting a delay for this reason.

Any ideas what's up? The doctor wants a speedy trial yet the defense is not complying with the judge's request.

Each side must share with the other side, what their witnesses and experts are going to say. Rules of Evidence require that this information is shared with the opposing side, 30 days before trial. If it's not shared 30 days before trial, then the opposing side is left at a disadvantage. Rules of evidence do not allow "surprises" on the stand. The opposing side can be admonished and sanctioned by the judge.

From what I've read in the news reports, Chernoff had the audacity to tell Judge Pastor that he did not take any notes when interviewing his expert and his expert did not prepare a report as to what his conclusions were.

This is unacceptable.

It's not clear to me from the news reports if Judge Pastor admonished just the defense or the prosecution. The news reports are conflicting on that. Some say just the defense, some say the admonishment was at both prosecution and defense, that both sides have delayed discovery.

So, fines can be levied, the trial could be delayed until the sanctioned side complies with the Judge's order, or even rarer, witnesses could be ruled unable to testify.

What it comes down to is a fair trial for the defendant. That all the rules of evidence (what can and cannot be testified to on the stand) are complied with by both sides.

Also, from my understanding, each ruling the Judge makes before and during the trial, can possibly be an appeal issue for the defendant, as long as the defense counsel raises an objection to the ruling on the record.

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